Studies in the News is a very current compilation of items significant to the Legislature and Governor's Office. It is created weekly by the State Library's Research Bureau to supplement the public policy debate in Californiaâ€™s Capitol. To help share the latest information with state policymakers, these reading lists are now being made accessible through the State Libraryâ€™s website. This week's list of current articles in various public policy areas is presented below.

Service to State Employees:

When available, the URL for the full text of each item is provided.

Items in the State Library collection can be checked out to state officials and staff.

Access to all materials listed will be provided by the State Information Reference Center, either by e-mail to cslsirc@library.ca.gov or by calling 654-0261.

["Study: AIDS Cocktails Very Effective for Kids: The Multipronged Therapies Slash the Death Risks for Youths: A four-year study of 1,028 HIV-infected children and teenagers found that combining protease inhibitors with standard AIDS drugs cut the risk of death by two-thirds, to less than 1 percent annually. Some children improved dramatically." Sacramento Bee (November 22, 2001) A24.]

["Nearly 15 million American adults - about one in every 14 - suffer from asthma, according to the government's first state-by-state survey of the respiratory disorder. About 6 million more adults say they have had asthma at some point in their lives, the Centers for Disease Control and Prevention reported." Sacramento Bee (August 17, 2001) A18.]

["A new case study highlights the epidemic of asthma in this neighborhood. According to the study, a recent survey found a full 10 percent of Bayview Hunters Point residents reported having asthma. For children, the rate was more than 15 percent.... The case study concludes that comprehensive health tracking ... is needed to help prevent asthma."]

New Asthma Estimates: Tracking Prevalence, Health Care, and Mortality. By the Centers for Disease Control, U.S. Department of Health and Human Services. (The Centers, Atlanta, Georgia) October 5, 2001. Various pagings.

["Tracking different aspects of asthma -- prevalence, health care utilization, and mortality -- provides information about how well the nation is addressing the different challenges posed by asthma.... The most recently available data on asthma gathered by the Centers for Disease Control Prevention are presented."]

["This paper investigates possible effects of political activity on pharmaceutical prices, with a particular focus on the health care reform period. It evaluates the extent to which pharmaceutical companies slowed the rates at which they increased prices in an attempt to preempt government intervention."]

["The Quality Initiative [was] created to work towards improving the quality of medical care through public reporting of comparative performance data and support for accountability and quality improvement efforts.... The survey ... conducted by RAND, provided important insight about the answers to critical questions ."]

["[The author] explores the concept of medical savings accounts (MSAs), examines their history, and shows how they have been working in practice. Regardless of the federal income tax treatment of MSAs, employers and individuals across the nation already have established and successfully used both federally qualified MSAs under the Health Insurance Accountability and Portability Act (HIPAA) and other 'nonqualified' MSAs.... [The author] analyzes the future of MSAs and outlines a number of policy measures that could improve and expand MSAs for everyone."]

Full Disclosure: Time for the Naked Truth About Health Care. By Elizabeth A. McGlynn and Robert H. Brook, Rand Center for Research on Quality in Health Care. (RAND, Santa Monica, California) August 2001. 4 p.

["Medical mistakes kill up to 98,000 Americans every year. Tens of millions of Americans receive treatment that is inadequate, incompetent, or unnecessary.... We recommend nothing short of a war on poor quality of care.... The primary weapon ... would be a national system to measure the quality of care everywhere. The cost would be a few billion dollars a year, but that is ... just a drop in the bucket of the nation's total annual health care bill of more than $1 trillion.

Business Initiatives to Expand Health Coverage for Workers in Small Firms. By Jack A. Meyer, Economic and Social Institute and Lise S. Rybowski, Severyn Group. Prepared for The Commonwealth Fund (The Fund, New York, New York) October 2001. 44 p.

["According to the report, purchasing coalitions have not been able to attract sufficient enrollment to lower costs through administrative efficiencies....Also, the report said that state regulations limit purchasing coalition's ability to meet small employers' needs" BNA's Health Care Policy Report (November 5, 2001) 1673.]

["Adults aged 50 to 64 who buy individual coverage pay much more out-of-pocket than they would through employer-based health plans.... The study maintains that older adults risk financial and health problems if they lose their jobs or retire early, thus severing their ties to employer-based insurance."]

["Rural America Suffers More Health Trouble: People who live in rural areas are not getting as much preventive care and medical treatment as other Americans. Long distances and the high rate of poverty among rural residents are two factors that make it tough to attract medical services." Sacramento Bee (September 10, 2001) A10.]

What Patients Think of California Hospitals. By the California Institute for Health Systems Performance and the California Health Foundation. (The Foundation, Oakland, California) 2001. Various pagings.

["All of California's acute care hospitals were invited to participate in the study and were told a report about the survey would be released publicly. Roughly 30 percent of the state's eligible hospitals signed on and turned over patient contact information.... Central Valley patients gave their hospitals mostly average marks for patient care." Fresno Bee (August 29, 2001) 1.]

["Nation's Changing Face of Hunger: While poverty by official measures has declined, other recent studies show food bank demand has climbed.... More than 23 million Americans nationwide sought emergency hunger relief this year from private food banks and other charities in the America's Second Harvest network, according to a recent study." Washington Times (November 25, 2001) B3.]

["This is the fifth ... annual assessment and interpretation of key trends in the managed care industry, and their affect on the nation's overall health.... This ... report provides an important glimpse into the prevailing practice patterns of physicians in managed care."]

The Measurement of Medicaid Coverage in the SIPP: Evidence from California, 1990-1996. By David Card, University of California, Berkeley, and others. Prepared for the Joint Center on Poverty Research. JCPR Working Paper 241. (The Center, Evanston, Illinois) September 2001. 41 p.

["This paper studies the accuracy of reported Medicaid coverage in the Survey of Income and Program Participation (SIPP) using a unique data set formed by matching SIPP survey responses to administrative records from the State of California. Overall, we estimate that the SIPP underestimates Medicaid coverage in the California population about 10 percent."]

["As the economy contracts, states face declining revenues and have fewer resources with which to pay for an expanding Medicaid program..... In this analysis, we estimate the effect of increased unemployment rates on Medicaid enrollment, estimate the impact of increased enrollment on Medicaid expenditures, and simulate the effect that increased federal matching rates might have on state Medicaid expenditures."]

["GAO said that 'the bills would provide expedited procedures for provider appeals, protections for providers who voluntarily return overpayments, and new requirements for provider education.... The report also found the legislation would grant new Medicare appeals rights to physicians and other providers'.... In addition, it would establish a new right to appeal deficiencies identified in inspections of institution, such as nursing homes, prior to the imposition of a sanction." BNA Health Care Policy Report (July 16, 2001) 1127.]

One-Third At Risk: The Special Circumstances of Medicare Beneficiaries with Health Problems. By Marilyn Moon and Matthew Storeygard, Urban Institute. Prepared for the Commonwealth Fund. (The Fund, New York, New York) September 2001. 26 p.

["Before contemplating reforms in Medicare, it is crucial to understand the needs of vulnerable groups the program serves so that the important achievement of providing mainstream coverage to these populations is not undermined.... Elderly and disabled people have a disproportionate share of chronic and acute conditions.... Consequently, these populations are the least attractive customers for the private insurance sector and the ones at whom Medicare reforms and protections should be targeted."]

["Collective Trauma Puts Spotlight on Mental Illness: The report focuses on mental disorders and urges governments to start addressing these problems.... [It] warns that one of every four people will be affected by mental or neurological disorders at some time." Washington Post (October 10, 2001) C12.]

["Although researchers excluded differences in physicians' experience, years of practice and location and patients' incomes, the study found that 'minority doctors are less able' to obtain health care services for patients, Hargraves said. He said that discrimination against minority doctors or patients 'could be a factor,' but added that patient income 'plays an important role.'" California Healthline (August 13, 2001) 1.]

["The U.S. Bureau of Labor Statistics projects that by 2020 there will be 20 percent fewer nurses than are needed.... Nurse shortages have been a high priority for state legislatures across the country. States' solutions vary from financial incentives to educational and licensing reforms to advisory commissions and workplace improvements."]

"106,982 direct care positions are vacant in nursing homes throughout the United States....The annualized turnover rate for CNAs, LPNs and staff RNs is 76.1 percent, 51.5 percent and 55.5 percent, respectively....AHCA officials believe that the severe need for nursing staff in nursing homes, as well as other long-term care facilities such as assisted living, may present an avenue of opportunity for workers displaced by the recent economic downturn." BNA's Health Care Policy Report (November 5, 2001) 1671.]

["Poor-Quality Patient Care Is More Likely To Be Found In For-Profit Facilities: Researchers examined 1998 government inspection records for 13,693 nursing homes that receive Medicaid payments -- nearly all such homes in the country. They found that inspectors cited for-profit nursing homes, 43 percent more frequently than public or government-run nursing homes". San Jose Mercury News (September 1, 2001) A1.]

Abuse of Residents Is a Major Problem in U.S. Nursing Homes. By Special Investigations Division, Committee on Government Reform, U.S. House of Representatives. Prepared for Representative Henry Waxman. (The Committee, Washington, DC) July 30, 2001. 19 p.

["Elder abuse of nursing home patients is 'widespread and serious' and increasing, according to a recent Congressional investigation requested by Rep. Henry Waxman,...Until lately, abuse in nursing homes has been handled more by state licensing inspectors than the police, but prosecutors are now turning a critical eye to the often hidden problem." Sacramento Bee (Sept 9, 2001) A3.

"Regulating Nursing Homes: Residential Nursing Facilities in the United States." By Charlene Harrington, Department of Social and Behavioral Sciences, University of California, San Francisco. IN: British Medical Journal, vol. 323, pp. 507-510.

["Over the past three decades, the poor quality of care in nursing homes has continued to be a problem. The nursing home industry is increasingly controlled by large and politically powerful multinational corporations. These corporations have wide discretion over the spending of large amounts of public funds, but ... there is little financial accountability. Fraud and financial mismanagement are widespread ... as is poor quality care."]

A Briefing Chartbook on Shortfalls in Medicaid Funding for Nursing Home Care. By BDO Seidman, LLP. Prepared for the American Health Care Association. (The Association, Frederick, Maryland) August 30, 2001. 20 p.

[The Medicaid program is underfunding nursing home care by at least $3.3 billion annually due to its payment of long-term care reimbursements that are considerably lower than the acknowledged price of delivering care to beneficiaries, according to an analysis."]

["North Carolina Governor Mike Easley signed a patients' rights bill, making his state the 46th to give more legal power to health care consumers. State officials say the new measure is the toughest in the country. Even so, without Congressional action on the issue, up to one third of Americans are not helped by state mandated laws. That's because most employer-sponsored health plans are regulated by the federal Employee Retirement Security Act, or ERISA, and are exempt from state mandates."]

["Current Issue Highlights Medical Education: A 1998 national survey of 2,626 residents in eight specialties found that although residents considered themselves prepared to manage most 'common conditions' they would face, more than 10% in each specialty reported that they 'felt unprepared to undertake one or more tasks' in their specialties." American Health Line (September 5, 2001) 1.]

["AMA Forges Ahead: Unveiling of Educational Campaign Paid by Drug Industry Triggers New Criticism: The American Medical Association finally rolled out its $1 million education campaign ...to help curtail the growing influence of America's multibillion-dollar drug companies.... The AMA acknowledged that most of the funding came directly from the drug companies themselves." Modern Healthcare (September 10, 2001) 22.]

["As benefits managers grapple with an increasingly complex and costly health care delivery system, a principal area of concern is the cost of providing prescription drug benefits. Prescription drugs and pharmacy services now account for more than 9% of health care expenditures."]

["States could save more than $1 billion by changing their pharmacy reimbursement formulas for Medicaid drug expenditures to better reflect the pharmacies' actual drug acquisition costs, according to a report.... However, a group representing chain drugstores faulted the report's findings as unrealistic and said the proposed change in the reimbursement formula would not reflect drugstores' true costs in providing prescription services."]

The Model State Emergency Health Powers Act: Draft. By The Center for Law and the Public's Health, Georgetown and Johns Hopkins Universities. Prepared for the Centers for Disease Control and Prevention. (The Center, Washington, DC) October 23, 2001. 40 p.

["A model law drafted for states at the request of the federal government would give authorities broad powers to close buildings, take over hospitals and order quarantines during a biological attack.... The draft ... provides a template for states to respond to the release of a deadly agent like smallpox or Ebola. Whether to adopt such a law is up to state legislatures." San Francisco Chronicle (October 31, 2001) A5.]

["While no stipulations were made on how the money could be spent, most states are using the funds to address health issues.... This Issue Brief highlights state initiatives for spending these revenues for fiscal 2001. A few state examples are given in each spending area to highlight the broad range of activities for using tobacco settlement dollars. Each example constitutes significant spending in that area."]

[â€œThis study evaluated a novel drug abuse treatment, the Therapeutic Workplaceâ€¦. Salary is linked to abstinence by requiring patients to provide drug-free urine samples to gain access to the workplaceâ€¦. The Therapeutic Workplace nearly doubled patientsâ€™ abstinence from opiates and cocaineâ€¦. These procedures have been effective in promoting abstinence from a wide range of drugs and in diverse patient populations.â€]

["Tax Credits: Report Says Idea Ineffective for Uninsured: In the report, Families USA analyzed insurance plans offered in 25 states.... Executive Director Ron Pollack said, 'The costs of individual health insurance are far more expensive than the cash value of pending tax-credit proposals. They are like throwing a 10-foot rope to a person at the bottom of a 40-foot hole.'" American Health Line (September 13, 2001) 1.]

["This analysis is based on 1999 National Survey of America's Families data, the most recent available at the time. In particular, it focuses on the pool of adults who would be potentially eligible to acquire COBRA coverage in the event of a layoff as well as on the insurance coverage distribution of unemployed workers."]

Diagnosing Disparities in Health Insurance for Women: A Prescription for Change. By Jeanne M. Lambrew, George Washington University. Prepared for the Commonwealth Fund Task Force on the Future of Health Insurance. (The Fund, New York, New York) 2001. 40 p.; Appendices.

["Women face unique and, compared with men, frequently greater challenges in accessing affordable health insurance.... This study explores the difficulties women encounter in obtaining health insurance. It then evaluates some major approaches to expanding health coverage for their potential to address these challenges."]

Creating a Culture of Retention: A Coaching Approach to Paraprofessional Supervision. By the Paraprofessional Healthcare Institute, National Clearinghouse on the Direct Care Workforce. PHI Technical Series Publication. (The Clearinghouse, Bronx, New York) September 2001. 28 p.

["This document introduces the coaching approach to supervision through a comparison with the more familiar traditional approach.... Subsequent sections outline the rationale, theory, and assumptions behind the coaching approach.... The last section deals with the challenge of implementing a coaching approach within the context of an organization."]

["According to the report, use of three-tiered plans jumped by 14 percent from 1999 to 2000, with 39 percent of employers reporting use of such a plan design in 2000, compared to 25 percent in 1999.... The apparent shift towards so-called incented formularies, in which lower copayments are used to motivate employees to choose lower-cost generics or 'preferred' brand-name drugs, and the increase in disease mangement programs comes as employers are seeking ways to curtail sharp increases in prescription drug spending and drug utilization." BNA's Health Care Policy Report (October 29, 2001) 1631.]

Oxymorons: The Myth of a U.S. Health Care System. By J. D. Kleinke. (Jossey-Bass, New York, New York) September 2001. 256 p.

[â€œHealth care in America is a sizable and growing middle-class jobs program. There are tens of thousands of well-meaning people working throughout the health care system, none of whom ever see a patient or deliver any actual medical care. They preside over an infinity of rules, regulations, forms, redundant processes, contract outsourcing, financial brokering, benefit plan tinkering, analytical processes, incompatible data systems, and dead forests of paperwork. The end-result of every attempt at 'reform' is the creation of more jobs.â€ NOTE: Oxymorons ... will be available for 3-day loan.]

[Includes: "Challenges and Options for Increasing the Number of Americans with Health Insurance;" "A Health Insurance Tax Credit for Uninsured Workers;" "Expanding Access through Public Coverage: Permitting Families to Use Tax Credits to Buy into Medicaid or SCHIP;" "Allowing Small Businesses and the Self-Employed to Buy Health Care Coverage through Public Programs;" and others.]